Provider Demographics
NPI:1679574644
Name:RANA, MOHAMMAD JAVED (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:JAVED
Last Name:RANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M. JAVED
Other - Middle Name:
Other - Last Name:RANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2003 LEATHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2026
Mailing Address - Country:US
Mailing Address - Phone:276-322-0000
Mailing Address - Fax:276-322-0003
Practice Address - Street 1:2003 LEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2026
Practice Address - Country:US
Practice Address - Phone:276-322-0000
Practice Address - Fax:276-322-0003
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18953207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010114918Medicaid
WV18953OtherSTATE LICENSE
P00140857OtherTRAVELERS
542154731OtherTAX ID#
550771289OtherTAX ID#
1518077890OtherCORPORATION NPI#
WV0080080000Medicaid
$$$$$$$$$OtherSS# FOR MOHAMMAD RANA, MD
VA010114918Medicaid
P00140857OtherTRAVELERS